Daily Care Strategies for the Periodontal Patient and Beyond!

Most patients spend anywhere from 24 to 60 seconds on oral care routines. So it is critical that clinicians explore new technologies and strategies to not only motivate patients but to increase the probability of success. Today, options for high tech oral hygiene are countless. While implementing clinical care strategies such as accelerated periodontal instrumentation, assuring optimal clinical results must include daily oral care recommendations.
Areas of particular concern for the periodontal case include:
Thorough daily mechanical biofilm removal from teeth, tongue and gingival margin;
Chemotherapeutics to control flora and neutralize volatile sulfur compounds (VSC); and
Remineralization and desensitization to restore, repair and prevent root decay while minimizing periodontal associated dentin sensitivity.
Mechanical Options and Considerations:
Tooth biofilm removal
Uniquely configured manual toothbrushes: Provide better access and guided positioning features; some include tongue cleaners.
Automatic/powered toothbrushes: Provide better biofilm removal in a shorter period of time; some research has demonstrated stain removal and prevention.
Interdental devices:
Toothpicks: Correctly used, these readily available interdental aids are highly effective and widely accepted by patients.
Automatic flossing devices: Provide equal results to traditional floss without the reliance on technique.
Medicament impregnated dental floss: VSC neutralizing agents or whitening additives lend to higher patient compliance.
Irrigation devices: Provide access to all oral niches and can be used with specific chemotherapeutic rinses.
Tongue cleaning devices
Plastic or metal designs: Provide more efficient biofilm removal and higher reduction of odor related VSC compounds than a toothbrush.
Daily biofilm removal and neutralization of VSC can be accomplished both mechanically and chemotherapeutically. The combination of the two will provide the best chance of clinical success and patient satisfaction.
Chemotherapeutic Options and Considerations
Zinc: The most recognized and effective VSC neutralizing agent.
Essential oils: Proven antimicrobial agent affecting VSC producing organisms.
Chlorhexidine gluconate: Broad-spectrum antimicrobial agent that also neutralizes VSC, combine with automatic toothbrush technologies in order to minimize staining.
– Chlorine dioxide: Proven VSC neutralizing agent.
– Cetylpyridinium chloride (CPC): Proven mild antimicrobial agent affecting VSC producing organisms.
– Triclosan: Proven mild antimicrobial agent affecting VSC producing organisms.
A combination of above agents may be needed to achieve BOTH antimicrobial and VSC neutralizing results. VSC’s not only produce odor but also have a role in periodontal infection and healing:
VSCs Role in Periodontal Disease
Bleeding on probing and pocket depth has been correlated with production of VSC’s
Pocket depths over 4mm are more likely to promote growth of VSC-producing organisms
Tongue coating 4 - 6x greater
Periodontal Pathogenesis of VSC
Increase in permeability of oral mucosa
Increase of penetration of endotoxin
Suppression of DNA synthesis
Interference with collagen and protein synthesis
Remineralization and Desensitization Options and Considerations:
5,000 ppm sodium fluoride will remineralize while decreasing sensitivity through insulation of the dentin tubules.
Stannous fluoride a known fluoride for affecting gram negative bacteria and its mechanical desensitizing properties, utilize automated toothbrush technologies to minimize stannous staining.
Calcium phosphate systems will enhance luster while decreasing sensitivity and impacting remineralization.
Potassium nitrate is known chemotherapeutic desensitizer and often combined with one or more of the above agents.
Combination of the above ingredients.
Strategic Success!
Motivating patients to optimal daily care can be challenging at times. Take the opportunity to correlate social based factors of interest to patients including fresh breath and brighter smile ‘outcomes’. The American Dental Hygienists’ Association defines optimal oral health as: ‘a standard of health of the oral and related tissues which enable an individual to eat, speak or socialize without active disease, discomfort or embarrassment and which contributes to general well-being and overall health” (Policy – 1999). This definition clearly acknowledges the importance of a patient-centered approach and provides the rationale to implement social based motivational strategies that will result in optimal oral health!